We thank Dr. Haynes for his letter. His comments raise some interesting points for discussion. He is concerned with our choice of sub-occipital duplex scanning of the vertebral artery (VA) and that it is, in his view, a major limitation of our study due to the lack of evidence of validity for scanning of this segment. This raises interesting issues. We chose to perform the evaluation of vertebral artery blood flow at the atlanto-axial segment for specific reasons. Firstly, this segment of the VA is the most tortuous region and most likely to undergo flow abnormalities on cervical spine rotation (). Secondly, it is where most VA incidents have been reported to occur (). (Source: Manual Therapy)

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A book such as this is long awaited. For years manual therapists have been using aspects of neurology in their practices (such as antagonist contraction to relax and assist stretching in the agonist muscle) but more recently there has been an interesting shift to incorporate other less obvious aspects of neurology. This was largely developed and pioneered by Professor Carrick, a chiropractor, but it has largely remained unavailable unless you attend his courses. As with many techniques it has its followers and its antagonists (!) it has not been subject to much in the way of peer reviewed research (as the author himself indicates) and to those of us that know very little about it, this book will be the first time that the technique has entered the wider domain, and the first time that it h…

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The objective of addressing sports traumatology is well illustrated by the fact that 7 of the 10 chapters (125 out of 174 pages) are devoted to the extremities. The choice of landmarks and tests in the chapter on the head and neck is also illustrative of this approach. The explanation and interpretation of tests is somewhat superficial and straightforward and there is no reference to the sensitivity and specificity of the tests. Fortunately the CD-ROM included with the book adequately compensates for the superficial descriptions in the text. For this CD-ROM the subject on whom the tests are illustrated is a normal uninjured subject and not a real patient. This is understandable given the ethical problems associated with using patients. Unfortunately it results in images in which signs to b…

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Abstract: Back pain treatment in water has been commonly used although there is little evidence about its effects. One purported advantage for exercise is the reduced loading due to the buoyant force. The purpose of this study was to compare stature change, as a marker of spinal loading, after sitting in aquatic and dry land environments. Fourteen asymptomatic volunteers had their stature measured in a precision stadiometer, before and after a bout of physical activity and during a recovery period either sitting in water (head out of water immersion; HOWI) and sitting in a chair on land (SITT). Stature loss following exercise was as expected similar in both groups (SITT=89.2±5.4% and HOWI=86.5±8.1%; p=0.33). When stature recovery was compared between the water and land environments, HOWI…

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Abstract: A systematic review of randomised controlled trials (RCTs) was conducted to determine the effectiveness of manual therapy (MT) techniques for the management of musculoskeletal disorders of the shoulder. Seven electronic databases were searched up to January 2007, and reference lists of retrieved articles and relevant MT journals were screened. Fourteen RCTs met the inclusion criteria and their methodological qualities were assessed using the PEDro scale. Results were analyzed within diagnostic subgroups (adhesive capsulitis (AC), shoulder impingement syndrome [SIS], non-specific shoulder pain/dysfunction) and a qualitative analysis using levels of evidence to define treatment effectiveness was applied. For SIS, there was no clear evidence to suggest additional benefits of MT to o…

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I consider that the paper by has some major flaws. The use of duplex scanning to compare with velocimetry is appropriate, as the literature supports the validity of VA duplex, and shows some uncertainty about the superiority of MRA over duplex for assessing VA stenosis (), as well as the lesser accessibility of MRA. However, the authors have relied solely on suboccipital duplex scanning with no evidence in the literature to support its validity, unlike mid-cervical scanning (). Hence, this is a major limitation for their comparison with velocimetry results, regardless of the repeatability of their duplex measurements. (Source: Manual Therapy)

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Irecieved an interesting study in my in box this morning. It finds that massage after exercise not only does NOT increase blood flow and, therefore, improve lactic acid removal, it decreases both blood flow and lactic acid removal.

It is reported:

Dr. Tschakovsky said that massage may act by decreasing inflammation, or it may produce a placebo effect. “There is so much inconclusive work out there, that we really don’t understand massage in the context of exercise,” he said.

Interesting study that seems to punch a hole in a long accepted belief on how to minimize pain after exercise.

Jason L. Harris

References

1. Wiltshire V, Poitras V, Pak M, et al. Massage impairs rather than enhances lactic acid removal from muscle after strenuous exercise. Presented at: annual American College of Sports Medicine conference; May 27-30, 2009; Seattle, Wash. Presentation Number: 09-SA-4065-ACSM.

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Acupuncture (sticking needles at specific points to a certain depth in the skin) is not an effective treatment for chronic low back pain. This may sound surprising as the media has jumped all over a new study that supposedly shows that acupuncture is more effective than “usual care”. Unfortunately - as the media usually does - they’ve misinterpreted the results of the study. In fact the study showed that there is no difference in the effectiveness between “fake” and “real” acupuncture. Meaning, there is no effect of acupuncture.

Steven Novella over at Science-based Medicine does a masterful job of explaining this in detail. Please visit his post on this study to become enlightened by logical and scientifically based thoughts and discussion - as opposed to hype.

Jason L. Harris

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The aims of this textbook are to introduce and explain fundamental principles of research and to demonstrate how evidence produced through research is applied to solving problems in health care. The focus on presenting basic concepts of research design, data collection, quantitative and qualitative methods of analysis, and research synthesis to heath care students allows the authors to achieve these aims. It is not the intent of this book to serve as an advanced research or statistics reference. (Source: Manual Therapy)

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Abstract: Prolonged sitting and psychosocial factors have been associated with musculoskeletal symptoms among adolescents. However, the impact of prolonged static sitting on musculoskeletal pain among South African high school students is uncertain. A prospective observational study was performed to determine whether sitting postural alignment and psychosocial factors contribute to the development of upper quadrant musculoskeletal pain (UQMP) in grade ten high school students working on desktop computers. The sitting postural alignment, depression, anxiety and computer use of 104 asymptomatic students were measured at baseline. At three and six months post baseline, the prevalence of UQMP was determined. Twenty-seven students developed UQMP due to seated or computer-related activities. An …

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